Health plans and TPAs
Health plans are insurance policies that private companies or government programs offer to cover healthcare costs for enrolled individuals. Third-party administrators manage and process insurance claims for these health and employee benefit plans, often serving as intermediaries among healthcare providers, payers and beneficiaries.
Top Stories
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News
26 Mar 2026
UnitedHealthcare launches AI chatbot for member care navigation
UnitedHealthcare said the AI chatbot will support customer advocates by handling simple care navigation tasks and referring members to advocates when needed. Continue Reading
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23 Mar 2026
CMS vows to ditch faxes for electronic claims attachments
A new final rule would establish standards for the electronic exchange of claim attachments for all HIPAA-covered entities by 2028. Continue Reading
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16 Jan 2020
2017 State Medicaid Spending Rose as Feds Withdrew Funding
State Medicaid spending from states’ own revenues increased as states took on more responsibility for their own Medicaid spending in 2017. Continue Reading
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15 Jan 2020
Cost of Cancer Care Reaches Nearly $150B Nationally
Many cancer patients struggle with out-of-pocket cancer care expenses, with one drug costing nearly $12,000 annually and FDA approved drugs priced over $100,000 a year. Continue Reading
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03 Jan 2020
Despite Early Low Enrollment, Federal Exchange Enrollment Steady
The federal exchange enrollment was around 20 percent lower than last year in an early analysis but rose to just shy of last year’s overall enrollment. Continue Reading
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26 Dec 2019
Best Practices to Address Opioid Use Disorder for Medicaid Directors
A new toolkit identifies best practices for Medicaid directors to address opioid use and substance abuse in their states. Continue Reading
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19 Nov 2019
How Patient Navigators Drive the Medicare Open Enrollment Season
Patient navigators leading Medicare open enrollment season report that the multitude of plans, regulatory changes, and new technologies confuse enrollees. Continue Reading
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27 Aug 2019
Medicare Plan Finder Aims for Price Transparency, Plan Comparison
The new CMS Medicare Plan Finder seeks to streamline price transparency and plan comparison through new features and a refreshed design. Continue Reading
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13 Aug 2019
How Health Policy is Working to Reduce Medicare Drug Spending
Policymakers have targeted Medicare drug spending from many angles to drive down healthcare costs. Continue Reading
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31 Jul 2019
Expanding Medicare Supplemental Benefits to Benefit Seniors
With fewer Medicare beneficiaries receiving supplemental coverage through employer-sponsored insurance, Medicare’s supplemental benefits should expand. Continue Reading
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24 Jul 2018
Generic Drugs Could Have Saved $3B for Medicare Part D Program
The Medicare Part D program could have saved $3 billion in 2016 if the payer encouraged generic drug substitution over the use of brand-name therapies. Continue Reading
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29 May 2018
Preventing Provider Fraud through Health IT, Data Analytics
Payers that want to improve their ability to detect and react to provider fraud must invest in health IT and data analytics solutions to flag criminal activity. Continue Reading
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07 Jun 2017
Two Payers Liable for $32.5M in Medicare Advantage Fraud Suit
Freedom Health and Optimum Healthcare have been ordered to pay $32.5 million for systemic Medicare Advantage fraud alleged by a whistleblower lawsuit. Continue Reading
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23 May 2017
Understanding the Basics of Accountable Care Organizations
Since their inception, accountable care organizations (ACOs) have blazed a path of innovation in the healthcare industry, from delivery to quality of care. Continue Reading
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13 Jan 2017
How Payers Can Improve HEDIS Quality Measure Performance
Population health management, health IT investment, and provider engagement need to be targeted to improve HEDIS quality measure performance. Continue Reading
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07 Oct 2016
How Medicare, Medicaid, and CHIP Guide the Health Payer Industry
Public coverage programs like Medicare, Medicaid, and CHIP are leading the way in value-based care payment models. Continue Reading
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05 Jul 2016
Why HEDIS Quality Measures Matter for Value-Based Care
HEDIS measures are being followed by public health payers that are moving into the value-based care sphere as well. Continue Reading
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30 Dec 2015
The History and Evolution of CHIP and the Medicare Program
When Lyndon B. Johnson took the presidency in 1964, the Medicare program was finally established as a system to provide healthcare coverage to elderly citizens around the nation. Continue Reading